Failure to Enforce Compliance and Ethics Program Regarding Vendor Kickbacks
Summary
The facility failed to effectively implement and enforce its compliance and ethics program, as evidenced by the actions of two employees in the activity department and business office. The Code of Ethics manual required all employees to undergo compliance training and to report any unethical, illegal, or unprofessional behavior. Despite this, Employee 1, the Activities Director, accepted monetary payments from an insurance vendor in exchange for introducing the vendor to residents and/or their responsible parties, resulting in several residents being signed up for the vendor's insurance plan. Employee 1 admitted to accepting payments on multiple occasions, motivated by financial need and persistent encouragement from the vendor. Employee 2, the Business Office Manager, was aware of the vendor's offers to compensate staff for facilitating insurance enrollments, having witnessed such discussions at a staff party and being directly offered payment to intervene with a resident's family regarding insurance enrollment. Despite completing annual training on the Code of Ethics and Corporate Compliance, Employee 2 did not report these unethical solicitations to facility leadership or the compliance hotline, as required by facility policy. Other employees who witnessed the vendor's discussions also failed to report the behavior. The Nursing Home Administrator confirmed that she was unaware of the vendor's actions and the employees' involvement until the investigation was initiated. The lack of reporting by both Employee 1 and Employee 2, despite their training and the facility's mandatory reporting policy, demonstrated a failure in the facility's internal controls to monitor adherence to statutes, regulations, and program requirements. This deficiency resulted in the facility's inability to prevent and detect criminal, civil, and administrative violations related to the Anti-Kickback statute and the facility's own Code of Ethics.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A CNA with a recent conviction for domestic violence, a disqualifying offense under state law, continued to provide direct care to all residents after the conviction. Facility leadership was aware of the conviction but allowed the CNA to work, citing personal character standards, despite not meeting the required time elapsed since probation discharge. This action was not in compliance with state regulations or facility policy.
Failure to Remove CNA Convicted of Disqualifying Offense
Penalty
Summary
The facility failed to ensure that a Certified Nurse Aide (CNA) who had been convicted of a disqualifying offense, specifically first-degree misdemeanor domestic violence, did not continue to provide direct care to residents. Personnel records, background check logs, and court documents confirmed that the CNA was arrested and later convicted of domestic violence. Despite this conviction, which is listed as a disqualifying offense under Ohio Administrative Code, the CNA continued to work in the facility and provide direct care to residents. The review of staff schedules showed that the CNA worked multiple shifts after the conviction date, while still on probation for the offense. Interviews with the Human Resources Director and the interim Administrator revealed that both were aware of the conviction but allowed the CNA to continue employment, citing the use of personal character standards. However, the CNA did not meet the specific requirement that at least five years must have elapsed since being fully discharged from probation for an offense of violence, as outlined in the relevant state regulations. Facility policy and the staff handbook clearly state that conviction of a relevant criminal offense may result in termination, and that staff are responsible for reporting such convictions. The facility's own documentation and interviews confirmed that the CNA's continued employment was not in compliance with state law or facility policy, as the CNA had access to all residents during this period despite the disqualifying conviction.
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release May 27, 2026) and official state health department websites — never guesswork.
Trusted by long-term care providers and associations.
